Healthcare Provider Details

I. General information

NPI: 1467309294
Provider Name (Legal Business Name): TRINITY JARED BLEVINS CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 N US HIGHWAY 25E
GRAY KY
40734-7099
US

IV. Provider business mailing address

164 MICHIGAN AVE
HINKLE KY
40953-5800
US

V. Phone/Fax

Practice location:
  • Phone: 606-258-8050
  • Fax:
Mailing address:
  • Phone: 606-269-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number4052595
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4052595
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4052595
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: